Provider Demographics
NPI:1053388769
Name:RINALDI WELDON, SUSAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:RINALDI WELDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1246 KALEO PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1535
Mailing Address - Country:US
Mailing Address - Phone:808-672-7246
Mailing Address - Fax:
Practice Address - Street 1:94-235 HANAWAI CIR
Practice Address - Street 2:SUITE 1B
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3029
Practice Address - Country:US
Practice Address - Phone:808-671-0090
Practice Address - Fax:808-671-5376
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-224363AM0700X
CAPA14515363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical